Provider Demographics
NPI: | 1558392977 |
---|---|
Name: | DUKE UNIVERSITY HEALTH SYSTEM, INC. |
Entity Type: | Organization |
Organization Name: | DUKE UNIVERSITY HEALTH SYSTEM, INC. |
Other - Org Name: | DUKE UNIVERSITY HOSPITAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP, FINANCE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | STUART |
Authorized Official - Last Name: | SMITH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 919-613-8995 |
Mailing Address - Street 1: | PO BOX 110566 |
Mailing Address - Street 2: | |
Mailing Address - City: | DURHAM |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27709-5566 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 919-620-4855 |
Mailing Address - Fax: | 919-620-4921 |
Practice Address - Street 1: | ERWIN RD |
Practice Address - Street 2: | |
Practice Address - City: | DURHAM |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27710-0001 |
Practice Address - Country: | US |
Practice Address - Phone: | 919-684-8111 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | DUKE UNIVERSITY HEALTH SYSTEM, INC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-07-05 |
Last Update Date: | 2022-07-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
104100000X, 1041C0700X, 207Q00000X, 207R00000X, 207RC0000X, 207RI0200X, 207V00000X, 207YP0228X, 208000000X, 2086S0120X, 2088P0231X, 363L00000X, 367500000X | ||
NC | 133V00000X, 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207YP0228X | Allopathic & Osteopathic Physicians | Otolaryngology | Pediatric Otolaryngology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2086S0120X | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | Group - Multi-Specialty |
No | 2088P0231X | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 8000318 | Medicaid | |
NC | 012WC | Other | GROUP # BCBS S. WORKERS |
NC | 2618052 | Medicare PIN | |
NC | CJ2240 | Medicare PIN | |
NC | 2321257A | Medicare PIN | |
NC | 8000318 | Medicaid | |
NC | 2321257 | Medicare PIN |